Injury mechanism of midfacial fractures in football causes in over 40% typical neurological symptoms of minor brain injuries.

PURPOSE: The injury mechanisms of midfacial fractures may be typical causes of concussion, but hardly any scientific data on midfacial injuries sustained in football are available. Head and brain trauma represent frequent injuries in athletes of different sports that require appropriate treatment by sports and trauma physicians. This study investigated the management of midfacial fractures in football and the association of such fractures with concomitant brain injury. METHODS: In a prospective cohort study lasting 24 months (2012 to 2013), midfacial injuries of football players were analysed with regard to the injury mechanisms, first aid procedures on the field, treatment and return-to-play. To analyse concomitant and potentially overlooked minor brain injuries due to the trauma, we retrospectively investigated the neurological symptoms of the study population. RESULTS: The study included 132 football players (37 semi-professionals and 95 amateurs) with midfacial fractures. The main injury mechanisms were head-to-head and head-to-elbow trauma. The mean period of return-to-play after trauma was 33.5 days, which was significantly shortened if a protective face mask was worn (mean 10.4 days earlier, p = 0.0006). Semi-professional football players returned to play earlier (p = 0.009) and more often used protective face masks (p = 0.001). 55 players (41.6%) had neurological symptoms immediately after trauma as a possible sign of concomitant minor brain injury. 5 of 132 players with concussion had been hospitalised for 24 h, but no persistent neurological symptoms were detected. CONCLUSION: In football, midfacial fractures represent moderate-to-severe injuries with time away from sports of more than 4 weeks. Over 40% of athletes with a midfacial fracture showed concomitant neurological symptoms as a sign of minor brain injury. Therefore, sports physicians and other staff supervising athletes in daily practice should be aware of the presence of neurological symptoms. LEVEL OF EVIDENCE: Level III.

The cement-augmented transiliacal internal fixator (caTIFI): an innovative surgical technique for stabilization of fragility fractures of the pelvis.

INTRODUCTION: Analyzing the different age groups in a population who suffered a pelvic ring fracture it becomes obvious that there are important differences between the pelvic ring lesions of an elderly patient compared to a young adult concerning trauma mechanism, fracture pattern and therapeutic options. In the elderly patient it is very important to achieve maximum of stability if surgery is necessary in order to avoid early failure of the ostheosynthesis under mobilization with full weight bearing. PATIENTS AND METHODS: 15 patients (14 female) with fragility fractures of the pelvis that required surgical stabilization were eligible to participate in this study from December 2012 to December 2014. Such details were documented and analysed as patient demographics, mechanism of injury, fracture classification, operative treatment and postoperative radiological parameters of achieved bone-implant interface. RESULTS: The average age of the patients was 79.9 years (SD 9.0 years). According to Rommens five patients had a fragility fracture of the pelvis Type II-c, one a Type III-c, six a Type IV-b and three a Type IV-c. Four patients were treated by a cement augmented transiliac internal fixation (caTIFI). Seven patients received a cement augmented iliolumbar fixation. In all these patients the Schanz screws applied to the ilium were placed in an oblique dorsoventral direction into the supraacetabular bone canal (mean length of screws 100 ± 20mm, max. 135 mm, min. 70 mm). Even though in four patients the iliosacral joint was hit tangential and one cortex perforation without any cement leakage appeared no revision surgery was necessary. Overall the clinical findings including mobilisation with full weight bearing showed a sufficient mechanically stability in all patients. CONCLUSION: The focus of this study was to describe the modified surgical technique of the caTIFI with placing the Schanz screws from the posterior superior iliac spine to the anterior inferior iliac spine into the supraacetabular bone canal. Usage of cannulated and perforated Schanz screws gives the opportunity to control the correct position of the screws before implanting them. Another advantage is that additional stability can be obtained by cement augmentation. We believe that the new technique of the caTIFI provides a greater intraoperative versatility and a greater mechanical stability for fragility fractures of the pelvis.

Timing and duration of the initial pelvic stabilization after multiple trauma in patients from the German trauma registry: is there an influence on outcome?

BACKGROUND: There is an ongoing debate about the systemic burden of early definitive fracture stabilization in multiply injured patients. In patients with extremity fractures, the benefit of limited initial surgery has been examined. In this retrospective analysis, we assessed whether differences in outcome can be attributed to the degree of initial surgery in polytrauma patients with pelvic-ring fractures. METHODS: Multiply injured patients of the German Trauma Registry (Injury Severity Score [ISS] > or =16) with pelvic-ring fractures in need of surgery were analyzed for independent effects of the duration and the timing of the initial surgical stabilization of the pelvis. We compared three subgroups according to duration (D) [short (S): <1 hour; intermediate (I): 1-3 hours; and long (L): >3 hours] and timing (T) [early (E): day 0; intermediate (I): days 1-3; and late (L): day >3]. In addition, a subgroup analysis dependent on injury severity was performed. Statistics included analysis of variance, post-hoc Tukey test, chi test, Student's t test, with significance at p < 0.05. RESULTS: Demographic data and injury severity were comparable between the groups. The duration of surgery was associated with a higher rate of liver failure (group D-S: 6%; D-I: 17%; D-L: 28%; p = 0.028). The timing of surgery was associated with a higher rate of renal failure (T-E: 17%; T-I: 3%; T-L: 5%; p = 0.021), multiorgan failure (T-E: 27%; T-I: 23%; T-L: 13%; p = 0.024) and mortality (T-E: 18%; T-I: 19%; T-L: 4%; p = 0.019). There was improved mortality, lower rates of multiorgan failure, and sepsis in patients with higher ISS for procedures less than 3 hours. CONCLUSIONS: In our retrospective analysis, both initial short as well as delayed surgery were associated with a lower rate of organ failure and mortality in multiply injured patients (ISS > or =16). This is especially supported for patients with high ISS.